Int J Geriatr Psychiatry
· 2026 Jul · PMID 42391498
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BACKGROUND: The National Health Service (NHS) England Primary Care Dementia Data (PCDD) provides a comprehensive dementia registry, underpinning national policy to improve diagnosis, care, and support. METHODS: This pape...BACKGROUND: The National Health Service (NHS) England Primary Care Dementia Data (PCDD) provides a comprehensive dementia registry, underpinning national policy to improve diagnosis, care, and support. METHODS: This paper evaluates the PCDD in comparison with international quality dementia registries (SveDem, NorCog, ADNeT). RESULTS: We highlight strengths in PCDD coverage and case ascertainment, but also weaknesses in diagnostic specificity and post-diagnostic metrics. CONCLUSIONS: We review currently collected metrics and discuss potential data expansions, including dementia severity and NICE-approved therapy uptake, alongside new targets, such as an 18-week standard for memory assessment service referrals.
Miao TT, Szilcz M, Chang Z
… +2 more, Wastesson JW, Johnell K
Int J Geriatr Psychiatry
· 2026 Jun · PMID 42322659
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BACKGROUND: Older adults represent a high-risk group for suicide and are frequently exposed to central nervous system (CNS) drugs. Yet, the role of CNS drugs in late-life suicide remains unclear. METHODS: We conducted a...BACKGROUND: Older adults represent a high-risk group for suicide and are frequently exposed to central nervous system (CNS) drugs. Yet, the role of CNS drugs in late-life suicide remains unclear. METHODS: We conducted a nationwide register-based matched case-control study (1:30) including all individuals aged 65 years and older who died by suicide in Sweden between 2007 and 2020. Each case was matched to controls from the general population on age and sex, alive at the index date. Use of CNS medications was examined within 1-month, 3-month, and 12-month windows prior to the index date (date of suicide). Conditional logistic regression was used to estimate odds ratios (ORs) with adjustment for sociodemographic factors, number of other classes of medications (proxy for comorbidities), frailty score, self-harm history and major psychiatric diagnoses. RESULTS: Among 5971 older adults who died by suicide, 71.7% of cases used at least one type of CNS drug (vs. 35.2% of controls), while 34.7% of cases had dispensations for three or more CNS drug types (vs. 7.3% of controls) within one year before death by suicide. The most common drug classes among cases were hypnotics and sedatives (46.5%) and antidepressants (38.8%). About one third of cases used anxiolytics (32.3%) or minor analgesics and antipyretics (29.9%). Compared with controls, individuals who died by suicide more often used hypnotics and sedatives (adjusted OR 3.54, 95% CI 3.32-3.77), anxiolytics (aOR 3.27, 95% CI 3.04-3.52), antidepressants (aOR 2.50, 95% CI 2.33-2.68), and opioids (aOR 1.93, 95% CI 1.79-2.09) within 12 months before suicide. Patterns were consistent across time windows. CONCLUSIONS: CNS medications are commonly dispensed before suicide in older adults, particularly hypnotics and sedatives, antidepressants, anxiolytics, and opioids. These findings describe medication use patterns preceding suicide and identify drug classes for further investigation.
Bélanger E, Couch E, Carroll M
… +4 more, Gadbois EA, Jutkowitz E, Van Houtven CH, Wetle TT
Int J Geriatr Psychiatry
· 2026 Jun · PMID 42299743
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OBJECTIVES: The objective of this study was to examine the long-term perceptions of the value of receiving an amyloid PET scan, a test used to diagnose Alzheimer's disease, among Medicare beneficiaries with cognitive imp...OBJECTIVES: The objective of this study was to examine the long-term perceptions of the value of receiving an amyloid PET scan, a test used to diagnose Alzheimer's disease, among Medicare beneficiaries with cognitive impairment and their care partners. METHODS: An exploratory qualitative research design was used. A total of 100 in-depth semi-structured interviews were conducted with a purposeful sample of CARE-IDEAS participants two to three years post-scan. A team of coders applied qualitative content analysis to identify content about the value of the scan, which was then analyzed using thematic analysis, and stratified by diagnostic category (mild cognitive impairment vs. dementia) and scan results (elevated amyloid vs. not elevated). RESULTS: A majority of amyloid PET scan recipients and their care partners emphasized major benefits of receiving the scan including increased certainty about diagnosis, the ability to prepare for the future, potentially accessing treatment or trials, the ability to contribute to research, and limited procedural risks. Some participants also reported concerns about the cost of the scan, the lack of effective treatment options and clear prognostic information, the limited impact on their lives or treatment plans, and the emotional toll of living with the results. Their views and endorsements of the scan were shaped by their health and personal circumstances (e.g., seen as less relevant among those with rapidly declining health), and by their preference for more information and involvement in decision-making. CONCLUSION: The perspectives of persons living with cognitive impairment and their care partners about the value of amyloid PET scans differed across disease trajectories and personal circumstances. These experiences should be taken into consideration when advising symptomatic patients on the benefits and drawbacks of biomarkers for Alzheimer's disease.
Illingworth CH, Pahar M, Braun D
… +16 more, Sproson L, Khan H, Mirheidari B, O'Malley R, Abdi S, Jama M, Yussuf I, Wang C, Lee S, Ng S, Ali N, Basharat T, Rauf MA, Nadeem A, Christensen H, Blackburn DJ
Int J Geriatr Psychiatry
· 2026 Jun · PMID 42250267
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BACKGROUND: Pen-and-paper cognitive assessment tools to detect dementia have higher rates of misdiagnosis amongst minority populations, especially those who complete the assessment in their second language. CognoSpeak is...BACKGROUND: Pen-and-paper cognitive assessment tools to detect dementia have higher rates of misdiagnosis amongst minority populations, especially those who complete the assessment in their second language. CognoSpeak is an automated cognitive assessment tool that uses machine learning to detect early signs of cognitive impairment from speech. We assess the utility of different pen-and-paper cognitive assessments and CognoSpeak in ethnic minority populations living in the UK. METHODS: Research champions from four community centres across Yorkshire recruited cognitively healthy adults from their community: 51 Somali, 50 South Asian (South Yorkshire), 50 Chinese, and 49 South Asian (West Yorkshire). Participants completed the Montreal Cognitive Assessment (MoCA), Rowland Universal Dementia Assessment Scale (RUDAS), Multicultural Cognitive Examination (MCE), and CognoSpeak. RESULTS: A high percentage (47.5%) of participants recruited from ethnic minority community centres were misclassified as cognitively impaired with the MoCA, compared to just 3.4% in the RUDAS and 2% in the MCE. An acoustic-based SVM model analysis of responses to CognoSpeak achieved 83% accuracy in the ethnic minority cohort, at a similar rate to monolinguals (86%). Linguistic and text-based models showed higher levels of bias. CONCLUSION: Cognitive assessments, such as the MCE and RUDAS, may be superior to the MoCA in multilingual ethnic minority populations. Automated AI tools like CognoSpeak show promise in reducing healthcare burden in detecting dementia; however, additional work is required on managing implicit bias in any AI model before they could be clinically implemented.
Privosnik L, Baxter R, Corneliusson L
… +2 more, Lövheim H, Sköldunger A
Int J Geriatr Psychiatry
· 2026 Jun · PMID 42250257
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OBJECTIVES: Nursing homes in Sweden provide housing and care for people aged 65 years or older who require assistance with everyday activities. An increasing number of nursing home residents have cognitive and functional...OBJECTIVES: Nursing homes in Sweden provide housing and care for people aged 65 years or older who require assistance with everyday activities. An increasing number of nursing home residents have cognitive and functional decline, which can result in additional time needed for care provision. This study aimed to explore changes in resource use and associated factors in Swedish nursing homes over a 5-year period. METHODS: This repeated cross-sectional study analyzed baseline (2013-2014) and follow-up (2018-2019) proxy-rated data from 4599 participants from the Swedish National Inventory of Care and Health in Residential Aged Care study. Resource use was measured using the Resource Use in Dementia scale. Descriptive statistics, t-tests, chi-square tests, and multiple linear regressions were performed. RESULTS: Total resource use increased from 7.15 h/day to 7.83 h/day between baseline and follow-up. The number of residents living in a dementia unit increased from 34.6% to 43%. Higher independence in activities of daily living was associated with lower total resource use at follow-up while living in a dementia unit was associated with higher total resource use. Higher total resource use was associated with seven neuropsychiatric symptoms. For residents living in a dementia unit, four neuropsychiatric symptoms were associated with higher total resource use. CONCLUSIONS: Resource use in Swedish nursing homes increased between baseline and follow-up. These results may inform future policy, financing, and implementation decisions to support resource utilization in nursing homes.
Barker MS, Joyce JL, Waltrip L
… +5 more, Chapman S, Gu Y, Sunderaraman P, Huey ED, Cosentino SA
Int J Geriatr Psychiatry
· 2026 Jun · PMID 42217241
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OBJECTIVES: Self-perceived cognitive difficulties are a potential early marker of Alzheimer's disease (AD), frequently co-occur with depressive symptoms. This has hindered consideration of these subjective cognitive diff...OBJECTIVES: Self-perceived cognitive difficulties are a potential early marker of Alzheimer's disease (AD), frequently co-occur with depressive symptoms. This has hindered consideration of these subjective cognitive difficulties as a risk factor for AD. However, accumulating evidence points to dissociations between specific depressive symptoms (i.e., apathy, affective or mood symptoms, and others), with some suggestion that apathy is particularly predictive of and more proximate to AD and may drive the relationship between depressive symptomatology and AD. This study examines whether apathy drives the association between depressive symptoms and subjective cognitive complaints (SCC). METHODS: 151 cognitively normal older adults (68% female, mean age 73 ± 7 years) completed a 20-item SCC questionnaire, the Apathy Evaluation Scale, and the Geriatric Depression Scale (GDS). RESULTS: Depressive symptoms (per GDS) were significantly associated with SCC (p = 0.008). However, affective symptoms (dysphoria, anxiety, hopelessness), were not statistically associated with SCC (p = 0.100), while apathy symptoms were (p < 0.001). In a mediation model, apathy mediated the relationship between depressive symptoms and SCC, accounting for 53% of the total effect, indicating that apathy may drive the relationship between depressive symptoms and SCC. When stratified by sex, the results remained significant for women only. CONCLUSIONS: These results underscore the relevance of apathy in pre-clinical stages of AD, such as SCC, particularly in women. Understanding the complex associations between SCC and depressive symptoms will help refine conceptualization of SCC as a risk factor for AD.
Int J Geriatr Psychiatry
· 2026 Jun · PMID 42217240
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OBJECTIVES: Dementia and cardiometabolic diseases are both characterized by long prodromal phases, which may complicate the assessment of their temporal relationships. Associations between cardiometabolic risk markers an...OBJECTIVES: Dementia and cardiometabolic diseases are both characterized by long prodromal phases, which may complicate the assessment of their temporal relationships. Associations between cardiometabolic risk markers and cognition remain inconsistent. We examined the associations between cardiometabolic risk markers and cognitive function in middle-aged and older adults. METHODS: A longitudinal analysis was conducted using data from a population-based cohort (2007-2014) of 1255 cognitively normal Koreans aged ≥ 50 years at baseline. Cardiometabolic risk markers and Korean Mini-Mental State Examination (K-MMSE) scores were repeatedly assessed through health examinations and interviewer-administered questionnaires. Multivariable linear regression (LR) and generalized estimating equation (GEE) models were used to investigate the associations between cardiometabolic risk markers and K-MMSE scores. RESULTS: After full adjustment for covariates, increases in the homeostasis model assessment of insulin resistance (HOMA-IR) and fasting insulin levels were associated with larger percent declines in K-MMSE scores and with lower K-MMSE scores in LR and GEE models (log-transformed HOMA-IR: β = -1.03, 95% CI: -1.87 to -0.20 for LR; β = -0.25, 95% CI: -0.41 to -0.08 for GEE). By age group, increases in HOMA-IR and blood pressure were associated with declines in K-MMSE scores among adults aged ≤ 65 years. By cognitive domain, increases in blood pressure were associated with declines in memory, while increases in HOMA-IR were marginally associated with declines in visuospatial ability (p = 0.052). High-density and low-density lipoprotein cholesterol levels were not significantly associated with cognitive function across all analyses. CONCLUSIONS: Our findings suggest that longitudinal increases in insulin resistance and blood pressure are associated with cognitive decline, particularly among middle-aged adults (≤ 65 years), and may differentially influence cognitive domains.
Shao X, Zhu L, Yang C
… +10 more, Zhou Q, Zhang F, Wang Y, Lu L, Zhang Z, Ren H, Ai Y, Gao X, Hu H, Xu M
Int J Geriatr Psychiatry
· 2026 May · PMID 42176345
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OBJECTIVES: The study was aimed to explore the effects of digital device use (digital use) on the psychological health and cognitive functions in Chinese older adults. METHODS: Participants (n = 1915) were extracted from...OBJECTIVES: The study was aimed to explore the effects of digital device use (digital use) on the psychological health and cognitive functions in Chinese older adults. METHODS: Participants (n = 1915) were extracted from the Chinese Longitudinal Aging Social Survey (CLASS) in 2018. The digital use was measured by the use of digital devices in different areas over the internet and their use proficiency. Cognitive functions (mainly orientation and calculation) were evaluated with items from the Mini-Mental State Examination (MMSE), while psychological health was measured by perceived loneliness and life satisfaction. Bayesian structural equation modeling was applied to examine the direct effects of digital device purposes and digital device proficiency on cognitive functions and psychological health (loneliness and life satisfaction) and the mediating effects of psychological health. RESULTS: Use purposes of digital devices positively influenced orientation (β = 0.33, 95% CI: 0.09-0.57) and negatively influenced perceived loneliness (β = -0.41, 95% CI: -0.55 to -0.28); proficiency had positive effect on loneliness (β = 0.24, 95% CI: 0.02-0.44) and negative effect on life satisfaction (β = -0.12, 95% CI: -0.22 to -0.03). Loneliness partially mediated the relationship between digital purposes and orientation (β = 0.07, 95% CI: 0.00-0.15), accounting for only 20% of the total effect. Crucially, loneliness directly impaired cognition, reducing both orientation (β = -0.17, 95% CI: -0.33 to -0.01) and calculation (β = -0.18, 95% CI: -0.31 to -0.06). CONCLUSIONS: Purposeful digital engagement can improve orientation and alleviate loneliness in Chinese older adults. It also helps preserve orientation ability partly by reducing feelings of loneliness, whereas use proficiency may exacerbate loneliness and diminish life satisfaction.
Hebditch M, Daley S, Rae P
… +3 more, Muszynska S, Feeney Y, Banerjee S
Int J Geriatr Psychiatry
· 2026 May · PMID 42142385
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OBJECTIVE: High-quality dementia care is underpinned by interprofessional collaborative practise, and healthcare training is a critical opportunity to develop these skills. This review aims to examine the evidence for wh...OBJECTIVE: High-quality dementia care is underpinned by interprofessional collaborative practise, and healthcare training is a critical opportunity to develop these skills. This review aims to examine the evidence for whether interprofessional dementia education for undergraduate healthcare students positively impacts outcomes related to collaborative practise. METHODS: Inclusion criteria consisted of papers investigating dementia interprofessional education interventions delivered within undergraduate education and that assessed outcomes relating to interprofessional collaboration. Searches were limited to papers published after 2014 and were conducted in eight databases: PubMed/MEDLINE, EMBASE, Web of Science, ERIC, The Cochrane Library, PsycINFO, CINAHL, Applied Social Sciences Index and Abstracts (ASSIA), British Education Index (BEI). A narrative synthesis was conducted and data quality was assessed. RESULTS: 11 papers, evaluating 11 different interventions, were included in the narrative synthesis. Four studies demonstrated positive changes in student attitudes or perceptions of interprofessional education or collaboration. Seven studies had evidence that students' knowledge or perceived skills about interprofessional collaboration increased. No evidence was presented for change in student behaviour, or impact on patients or organisational practise. Three studies presented findings on outcomes specifically relating to interprofessional dementia care. CONCLUSIONS: The findings suggest that dementia interprofessional education may contribute to interprofessional competencies. Therefore, interprofessional education could provide added value to dementia education, both of which are high priorities in the undergraduate curriculum. However, the strength of the evidence was weak as the methodological quality of the papers was low. Additionally, interventions were varied and therefore, optimal components of dementia interprofessional education were not identified. More rigorous investigation is needed on the impact of dementia interprofessional education with a focus on the longer-term impact on student practise and service delivery.
Kramarczyk D, Ballard C, Corbett A
… +4 more, Da Silva MV, Mcleish KI, Cummings J, Khan Z
Int J Geriatr Psychiatry
· 2026 May · PMID 42104909
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OBJECTIVE: To evaluate racial and ethnic representation and temporal trends in phase II-IV dementia clinical trials conducted in the United States, United Kingdom, and Canada. METHODS: We interrogated ClinicalTrials.gov...OBJECTIVE: To evaluate racial and ethnic representation and temporal trends in phase II-IV dementia clinical trials conducted in the United States, United Kingdom, and Canada. METHODS: We interrogated ClinicalTrials.gov for interventional dementia and Alzheimer's disease (AD) trials completed since 2000. Data on age, gender, and ethnicity were extracted from 163 eligible trials. Representation was compared across two time periods (2000-2015 and 2016-2019) to assess progress in diversity. RESULTS: Of the 163 trials, 58.9% (n = 96) reported ethnicity data. Among the 12,900 participant records in these trials, 80.6% were Caucasian. Since 2016, despite improved reporting standards (100% of recent trials reported ethnicity), actual diversity declined: Asian participant representation dropped from 4.9% to 1.2%, and Hispanic/Latino representation fell from 2.2% to 0.7%. No ethnic minority group showed an increase in participation over the study period. CONCLUSIONS: Diverse ethnic groups remain significantly underrepresented in dementia clinical trials, with diversity metrics stagnating or declining over the last decade. Greater inclusivity in trial design and recruitment is urgently required to ensure that emerging dementia treatments are safe and effective for all populations.
Segaux L, Poitrine E, Nicodème M
… +10 more, Herr C, Vaillant-Ciszewicz AJ, Hurtaud A, Bombenger N, Boiteux-Chabrier M, Michel E, Maurice C, Gilbert C, Canoui-Poitrine F, Fromantin I
Int J Geriatr Psychiatry
· 2026 May · PMID 42068571
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OBJECTIVES: Loneliness and social isolation are major public health concerns among older adults and are associated with depression, cognitive decline, frailty, and loss of independence. Companion animals (and dogs in par...OBJECTIVES: Loneliness and social isolation are major public health concerns among older adults and are associated with depression, cognitive decline, frailty, and loss of independence. Companion animals (and dogs in particular) might mitigate these adverse outcomes by fostering emotional support, physical activity, and social interactions. The objective of the present study aimed to evaluate the association between dog ownership and loneliness in community-dwelling older adults. METHODS: C-KDOG is a multicentre, cross-sectional study conducted between September 2020 and April 2023 at seven investigating centers in France. The participants were aged 75 or over and were living at home. Loneliness was assessed on the 11-item De Jong Gierveld Loneliness Scale. The secondary outcomes included emotional and social loneliness subscores, social isolation (according to the Social Network Index). Associations between dog ownership and loneliness were analyzed using multivariable linear regressions adjusted for sociodemographic, environmental and clinical characteristics. RESULTS: A total of 160 participants were included, of whom 47 were dog owners (mean age: 82 years; females: 116 (73%); living alone: 79 (49%)). The median overall loneliness scores did not differ significantly when comparing dog owners and non-owners. In adjusted models, however, dog ownership was independently associated with lower loneliness. This association was mainly driven by a lower emotional loneliness subscore. Living alone, frailty, depressive symptoms, and sleep problems were independently associated with a greater level of loneliness. Dog ownership was primarily motivated by companionship (81%). Adverse events (such as falls or bites) were rare (5%). CONCLUSIONS: Dog ownership was associated with a lower level of emotional loneliness among community-dwelling older adults, independently of living alone frailty and depression. Companion dogs might contribute to emotional well-being in older adults. However, longitudinal studies are needed to confirm causality.
Cabrol A, Shourick J, Coley N
… +6 more, Oustric S, Guyonnet S, Vellas B, Escourrou E, Andrieu S, IHU HealthAge INSPIRE/Open Science study group
Int J Geriatr Psychiatry
· 2026 May · PMID 42059106
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OBJECTIVES: Existing literature indicates that subjective age-the age an individual feels or perceives themselves to be-is associated with various health outcomes. However, its relationship with global indicators such as...OBJECTIVES: Existing literature indicates that subjective age-the age an individual feels or perceives themselves to be-is associated with various health outcomes. However, its relationship with global indicators such as intrinsic capacity remains inadequately explored. The primary objective of this study was to investigate the association between subjective age and intrinsic capacities, which encompass mobility, cognition, hearing, vision, mood, and nutrition. METHODS: A cross-sectional analysis was conducted at baseline, followed by a longitudinal analysis over 8 months, based on the INSPIRE-T project launched in 2019 at a single center in Toulouse, France. The study included individuals aged 50 and above, with 744 participants at baseline, decreasing to 557 for the longitudinal analysis. Bivariate and multivariate logistic regressions were performed for each component of intrinsic capacity and a linear regression was conducted on a global score for impaired intrinsic capacities (0-6). RESULTS: Participants had a mean age of 70.9 years, and 457 (61%) were women. Compared to feeling one's age, feeling younger was significantly associated with less impairment in the intrinsic capacity global score both cross-sectionally (-0.23 [-0.39 to -0.07]) and at 8 months (-0.18 [-0.35 to -0.01]). Feeling older exhibited a non-significant opposite trend. Analysis of each intrinsic capacity domain revealed associations between subjective age and mood, mobility, and hearing. CONCLUSIONS: This study demonstrates that feeling younger than one's age is associated with better overall intrinsic capacities at baseline and lesser decline over the monitoring period. Routine assessment of subjective age could help to identify individuals who may benefit from prevention strategies and could promote patient-centered care by providing deeper insights into individuals' perceptions of aging. TRIAL REGISTRATION: The INSPIRE-T study has been registered on the site http://clinicaltrials.gov (ID NCT04224038) on October 15, 2019.
Soberano D, Ferreira AR, Freitas A
… +2 more, Fernandes L, Gonçalves-Pinho M
Int J Geriatr Psychiatry
· 2026 May · PMID 42059056
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BACKGROUND: Bipolar disorder (BD) in older adults is linked to significant medical comorbidities and hospitalization burden, yet nationwide data remain scarce. This study aims to compare younger versus older BD hospitali...BACKGROUND: Bipolar disorder (BD) in older adults is linked to significant medical comorbidities and hospitalization burden, yet nationwide data remain scarce. This study aims to compare younger versus older BD hospitalization trends, patient characteristics, and the impact of comorbidities on hospitalization outcomes in Portugal (2008-2015). METHODS: A retrospective observational study was conducted using a Portuguese administrative database, selecting hospitalization episodes of patients aged ≥ 60 years with a primary BD diagnosis. Variables analyzed included demographics, psychiatric comorbidities, Charlson Comorbidity Index (CCI), length of stay (LoS), in-hospital mortality, hospital charges, and readmissions. RESULTS: From a total of 21,793 BD hospitalizations, there were 4801 (22.0%) BD-related hospitalizations in the older age group, and the annual hospitalization rate was 23.4 per 100,000 inhabitants. The median admission age was 66.0 years, and 67.7% were female. BD type I with a manic episode (32.9%) was the most frequent subtype, and 85.5% of admissions were emergent. The median LoS was 18.0 days, significantly longer than in younger adults (p < 0.001). Readmission occurred in 52.4% of cases, with in-hospital mortality at 0.7%. Comorbidities were present in 23.0% of hospitalizations, with diabetes (13.1%) and dementia (3.2%) being most prevalent. LIMITATIONS: The study relies on secondary administrative data, subject to coding inaccuracies, and its retrospective design limits causal inferences. CONCLUSIONS: BD hospitalizations in older adults carry a high medical burden, with comorbidities impacting outcomes. Early screening, multidisciplinary care, and targeted interventions are crucial to improving management and reducing hospitalizations. Further research is needed to explore long-term outcomes and outpatient care strategies.
Int J Geriatr Psychiatry
· 2026 May · PMID 42048170
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INTRODUCTION: Late-life depression (LLD) is a heterogeneous psychiatric condition characterized by a wide range of psychopathological symptoms and associated with functional and structural abnormalities in brain networks...INTRODUCTION: Late-life depression (LLD) is a heterogeneous psychiatric condition characterized by a wide range of psychopathological symptoms and associated with functional and structural abnormalities in brain networks implicated in mood and cognitive regulation. This cross-sectional study investigated the relationship between specific depressive symptom dimensions and cortical brain measures, as assessed by magnetic resonance imaging, in a sample of 87 community-dwelling older adults with depression. RESULTS: Significant associations were identified between the severity of sad mood and reduced cortical volume in the right medial orbitofrontal cortex (OFC) (p [FDR] = 0.047), as well as reduced cortical thickness in the left OFC (p [FDR] = 0.008), left ventrolateral prefrontal cortex (VLPFC) (p [FDR] = 0.02), and right dorsolateral prefrontal cortex (DLPFC) (p [FDR] = 0.054). Apathy/lassitude was also significantly associated with reduced thickness in the left OFC (p [FDR] = 0.016) and left VLPFC (p [FDR] = 0.046). Moreover, overall depression severity correlated with reduced thickness in the right middle temporal cortex (MTC) (p [FDR] = 0.035). DISCUSSION: Our results suggest that feelings of low mood and lassitude in LLD are linked to structural changes in brain regions involved in emotion regulation, motivational drive, self-referential thinking, executive control, and decision-making. The findings contribute to the understanding of the neurobiological underpinnings of LLD and support the hypothesis that symptom-specific disruptions within mood and cognitive processing circuits are integral to its pathophysiology.
Miguel ACC, Martins-Teixeira L, Godoy C
… +4 more, Lima GMA, Lima-Costa MF, Barbosa MG, Ferri CP
Int J Geriatr Psychiatry
· 2026 Apr · PMID 42033766
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OBJECTIVE: To estimate the national proportion of undiagnosed dementia cases in Brazil, examine its distribution across Brazilian regions sociodemographic subgroups, and identify factors associated with receiving a diagn...OBJECTIVE: To estimate the national proportion of undiagnosed dementia cases in Brazil, examine its distribution across Brazilian regions sociodemographic subgroups, and identify factors associated with receiving a diagnosis. METHODS: We conducted a cross-sectional, population-based analysis using baseline data (2015-2016) from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative survey of community-dwelling adults. Dementia was identified through an established algorithm incorporating cognitive testing and functional impairment, combined with self-reported medical diagnosis of Alzheimer's disease. Underdiagnosis was defined as meeting dementia criteria without a prior medical diagnosis. Sociodemographic, clinical, cognitive, and functional variables were assessed. Survey-weighted logistic regression models estimated factors associated with underdiagnosis. RESULTS: Among 5249 participants aged ≥ 60 years, 392 met criteria for dementia. Overall, 83.1% (95% CI: 76.5-88.1) had no previous diagnosis. Underdiagnosis was more frequent in poorer regions (90.2%) than in richer regions (76.0%), and higher among illiterate individuals (93.9%). In fully adjusted models, older age (OR = 0.91; 95% CI: 0.85-0.97), more years of education (OR = 0.86; 95% CI: 0.76-0.96), a higher number of chronic conditions (OR = 0.72; 95% CI: 0.54-0.97), and better memory performance (OR = 0.68; 95% CI: 0.56-0.84) were associated with a lower likelihood of underdiagnosis, while living alone was associated with a higher likelihood of underdiagnosis (OR = 3.65 [1.05-12.6]). CONCLUSIONS: About four in five older Brazilians meeting dementia criteria had no prior clinical diagnosis, with marked sociodemographic and regional disparities. Both individual factors-such as age, education, and multimorbidity-and structural inequities across regions influenced diagnostic likelihood. Strengthening early-detection strategies, improved health professional training, and regionally tailored approaches may improve recognition of dementia in Brazil's public health system.